Provider Demographics
NPI:1629089107
Name:JAFFE, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JONATHAN
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 ROCKLEDGE DRIVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-530-4800
Mailing Address - Fax:301-530-1847
Practice Address - Street 1:6410 ROCKLEDGE DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-530-4800
Practice Address - Fax:301-530-1847
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25894207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61985Medicare UPIN
MD129376D09Medicare ID - Type Unspecified